Nurse-visit program for families faces uncertain funding

Originally published April 21, 2014 at 5:00 pm
Updated April 21, 2014 at 7:01 pm

Earlean Hicks, far left, a parent educator with the Children’s Home Society of Washington, visits with Anna Powell, center, and her children at home in Kent. The program works with families with young children to support healthy development and school readiness. Powell’s baby, King Graham, 5 months, and Heaven Powell, 4, are in front. Melvin Powell, 5, is behind.

Heaven Powell, 4, left, and King Graham, 5 months, listen to King’s father, Terrance Graham, read during a home-visit session. Graham, who is recently out of the Marine Corps, said the program helped him readjust back into society and family life.

WASHINGTON — If parents are their children’s first and best teachers, the role has sometimes left Anna Powell feeling overwhelmed.

Powell also has a 4-year-old daughter who has a learning disability, the same handicap Powell wrestled with as a girl. In December, Powell’s marriage officially ended, a month after the birth of her fifth child.

Into this tumult walked Earlean Hicks. Every other week for the past year, Hicks, a parent educator with the Children’s Home Society of Washington, has come to Powell’s home to listen, guide and help her bear the particular demands of her motherhood.

“When you have so many different kids that have so many different needs, things slip,” said Powell, 31. “Earlean helps you understand these are things you go through and that life has a lot of curveballs.”

Hicks’ visits are paid for in part by the federal Maternal, Infant and Early Childhood Home Visiting program. As part of the 2010 Affordable Care Act, Congress authorized $1.5 billion over five years to send nurses, social workers and others into homes where outside help might improve a child’s future. Oftentimes, that means working with young, single, low-income mothers.

Supporters, chief among them Democratic Sen. Patty Murray of Washington, believe the visits pay long-term dividends by better preparing children for school and life. But budget feuds between Republicans and Democrats have left Congress little time to deliberate on the merits and design of such programs.

Recently, with the expiration of the nurse-visit program looming at the end of the current fiscal year in September, Murray secured a six-month, $200 million extension by asking Senate Majority Leader Harry Reid to attach it to an unrelated Medicare physician-reimbursement bill.

Murray, who during the mid-1980s taught at Crystal Springs Preschool in Bothell and at a Shoreline Community College co-op program for parents and educators, often says she’s seen the value of early childhood support up close.

Research on the effectiveness of home visits are promising, if not conclusive. Programs in New York and Alaska, for instance, helped parents reduce serious physical abuse or improved children’s behavior. A randomized experiment with nearly 200 families in Arizona found that parents who received home visits were much less likely to slap or throw things at a child. But the 2011 study found no significant differences in other measures, including how frequently mothers read to children.

That lack of robust evidence about how well the visits work was a focus of a hearing of the Human Resources Subcommittee of the House Ways and Means Committee earlier this month chaired by Rep. Dave Reichert, R-Auburn.

Reichert, who as a teen ran away from home from an abusive father, noted such programs can benefit kids who got a rough start in life.

“I know if we put the money up front, we can be saving a lot of money in the back end,” Reichert, a former King County sheriff, told witnesses.

However, it’s critical, Reichert said, that taxpayer money go only to evidence-based approaches with proven outcomes. And he wondered how much of the tab for state programs should be picked up by the federal government.

Law-enforcement officials are among the home-visit programs’ biggest supporters. John Urquhart, the present King County sheriff, said it’s “intuitive” that early intervention will help families thrive and keep kids in school longer.

“It’s an investment worth making,” he said.

Federal support for home-visit programs began as a pilot effort in 2007 under President George W. Bush. Murray and other lawmakers helped turn it into a nationwide program in 2010. In addition to the share every state gets, Washington is one of 10 states that has received competitive grants to expand the visits. In fiscal 2013, federal support to the state totaled $10.4 million.

That money is given to two dozen organizations — from Public Health — Seattle & King County to Yakima Valley Memorial Hospital Association — that follow specific models for the visits.

Powell, the Kent mother, said her parents and her former mother-in-law live nearby and help as they can. Still, she said, she treasures Hicks’ nonjudgmental advice.

Hicks, a mother of six herself, stays for an hour or two during her visits. She checks in on Powell’s youngest, the 5-month-old boy who is her official client. But Powell says Hicks is attentive as well to the older children.